Pennsylvania’s Yellow Dot Program was created to assist citizens in the “golden hour” of emergency care when they may not be able to communicate their needs themselves. The form below, when completed, provides every piece of information an ambulance crew needs to care for you or a loved one during a medical emergency, including medications, allergies, medical history, etc. It is extremely helpful to EMTs, firefighters, and police officers to have this information available and waiting at your residence should the need arise.

To participate in the program simply print out the form, fill it out in dark pen, and attach it to your refrigerator with a magnet or tape.

In the 12 months this program has been active in Springfield, many residents have already begun to participate, facilitating a more complete transfer of information, and ultimately more reliable medical treatment.